Acromioclavicular joint reconstruction: an additional acromioclavicular cerclage does not improve horizontal stability in double coraco‐clavicular tunnel technique

• DOI: 10.1007/s00167-019-05674-1
• Publication Date: 2019-08-16T19:02:23Z
• Authors: Jan Theopold; Tobias Schöbel; Jean‐Pierre Fischer; Sabine Löffler; Georg Osterhoff; Stefan Schleifenbaum; Pierre Hepp
• Keywords: Aged, 80 and over; Joint Instability; Arthroscopy; 03 medical and health sciences; 0302 clinical medicine; Acromioclavicular Joint; Cadaver; Humans

AbstractPurposeHorizontal instability—especially in the posterior plane—is a common problem after acromioclavicular joint injuries. The purpose was to compare the stability of a single coraco‐clavicular tunnel technique and a double coraco‐clavicular tunnel technique for coraco‐clavicular ligament reconstruction and to examine the influence of an additional acromioclavicular cerclage on the horizontal stability in the acromioclavicular joint.Methods21 acromioclavicular joints of human cadaveric shoulders were randomly assigned to the following groups: single coraco‐clavicular tunnel technique with horizontal augmented acromioclavicular cerclage (SCT + AC); double coraco‐clavicular tunnel technique (DCT); double coraco‐clavicular tunnel technique and acromioclavicular cerclage (DCT + AC). The specimens underwent cyclic horizontal testing and were recorded using a 3D optical measuring system.ResultsThe displacement and the increase in displacement in relation to the displacement after precondition for SCT + AC were significantly higher after every measured amount of cycles than for DCT (p10 = 0.0023; p5000 = 0.0012) and DCT + AC (p10 = 0.0006; p5000 = 0.0012). There was no significant difference in the total displacement, or in the increase in total displacement between double coraco‐clavicular tunnel reconstructed groups with and without additional acromioclavicular cerclage.ConclusionDouble coraco‐clavicular tunnel technique with and without additional acromioclavicular cerclage results in a significant higher stability regarding the horizontal plane in comparison to single coraco‐clavicular tunnel technique with acromioclavicular cerclage. Based on the results of this biomechanical in vitro study, the use of an additional acromioclavicular cerclage with single coraco‐clavicular tunnel technique may not be indicated in most cases. The effect of an additional acromioclavicular cerclage seems to be negligible, at least in presence of a double‐coraco‐clavicular tunnel technique reconstruction. Techniques of AC joint reconstruction should focus on the use of double coraco‐clavicular tunnel devices.